No recurrences in selected patients after curettage with cryotherapy for grade I chondrosarcomas

Abstract

Background: The low aggressiveness of Grade I chondrosarcomas is compatible with conservative surgical treatment.

Questions/purpose: We asked whether combined curettage and cryotherapy would yield low rates of recurrence and whether supplemental internal fixation would retain function with low rates of complications in patients with Grade I central chondrosarcomas of the proximal humerus or distal femur.

Methods: We retrospectively reviewed 15 patients: nine women and six men with a mean age of 45 years (range, 26-70 years). All patients underwent curettage and cryosurgery through a cortical window; we replaced the window and plated the region with at least three screws beyond the curetted area. None of the patients was lost to followup, and 14 patients (93%) were reexamined by us after a minimum of 5 years (mean, 8 years; range, 5-11 years).

Results: There were no perioperative anesthetic, neurologic, hardware, or healing complications. None of the patients had local recurrence or metastases develop. At last followup, the Musculoskeletal Tumor Society score was 27.9 (range, 22-30) and all patients had resumed their previous activities. No complications were associated with this simplified cryotherapy technique.

Conclusions: The data confirm the appropriateness of conservative surgery for central low-grade chondrosarcomas of the proximal humerus and distal femur based on a combination of intralesional curettage and cryogenic parietal sterilization. Candidates for this approach should be chosen on the basis of the affected bone site, local extension staging, and clinicopathologic grading. We recommend supplementary internal fixation.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

This central chondrosarcoma of the proximal humerus was revealed by a calcifying tendinitis of the infraspinatus muscle. It had scintigraphic uptake greater than that of the ipsilateral iliac crest.

Fig. 2A–B

Preoperative (A) coronal and (B) axial-transverse MR images show a proximal humeral chondrosarcoma that is strictly intracompartmental with cortical erosion but without perforation.

Fig. 3

This postbiopsy image shows fixation of the osseous valve by four interference short screws to prevent extracompartmental spillage of the tumor through the osseous window.

Fig. 4A–B

The postoperative radiographs show little modification between (A) 1 and (B) 8 years of followup. There is a slight densification and remodeling of the osseous operative area without any evidence of cryogenic necrosis or tumor recurrence.

Fig. 5

Host bone entrapment in well-differentiated cartilaginous tumor is a major architectural feature for the diagnosis of Grade I chondrosarcoma, especially if there is a lack of nuclear atypia. Presence of an area with higher cellularity and myxoid changes in other fields leads more easily to a diagnosis of malignancy (Stain, hematoxylin and eosin-safran; original magnification, ×100).